ECG Monitoring of Myocardial Ischemia for Perioperative Care …
D-2431-2009
ECG Monitoring of Myocardial Ischemia for Perioperative Care Patrick Friederich
ABOUT THE AUTHOR |
About the Author
Professor Dr. med. Patrick Friederich Professor of Anesthesiology and Chairman, Department of Anesthesiology, Critical Care Medicine, and Pain Therapy, Klinikum Bogenhausen, Academic Hospital of the Technische Universit?t M?nchen, Munich, Germany. Professor Friederich's primary area of research focuses on perioperative cardiac electrophysiology. He has published numerous articles in leading international journals and serves as a highly recognized international reviewer of peer-reviewed articles. He has a long-standing record of international lecturing and regularly organizes workshops and symposia on ECG interpretation at national and international meetings.
D-4722-2011
02|03
Professor Friederich is board certified in Anesthesiology, Critical Care Medicine, Accident and Emergency Medicine, as well as Quality Management, and holds specialist certifications in Echocardiography, OR-Management and Health Care Economics. Over the last decade, he has received numerous research awards, including the Research Award of the European Society of Anaesthesiologists, Glasgow (2003), Vienna (2005) and Munich (2007).
Contact: patrick.friederich@klinikum-muenchen.de
Notice Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided on procedures or by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Author assume any liability for any injury and/or dam- age to persons or property arising out of or related to any use of the material contained in this book.
TABLE OF CONTENTS |
TABLE OF CONTENTS
1.0 Preface
07
2.0 Physiology and Electrophysiology of the Heart
10
2.1 Basic ECG morphology and interpretation
10
2.2 ECG and cardiac cycle
17
2.3 ECG lead vectors
20
2.4 Hexaxial reference system
24
2.5 Perioperative placement of ECG electrodes
26
3.0 ECG Changes during Myocardial Ischemia and Infarction
33
3.1 Definition of myocardial infarction
35
3.2 Time course of ECG changes after myocardial infarction
37
3.3 Localization of myocardial ischemia and infarction
37
3.4 The J-point
40
4.0 Perioperative Myocardial Ischemia and Infarction
42
4.1 Preoperative assessment
43
4.2 Intraoperative ischemia monitoring
43
4.3 Postoperative Surveillance
47
4.4 Perioperative anti-ischemic therapy
48
5.0 Real-Life Problems and Technical Solutions
49
5.1 Signal filtering
49
5.2 The battery effect of ECG electrodes
51
5.3 Body movement
52
5.4 Power supply interference
53
5.5 Electrocautery interference
54
6.0 Reliability of Perioperative ST Segment Analysis
55
6.1 Effect of the high-pass filter on ST analysis
56
6.2 Automated ST segment analysis
58
6.3 How the ST algorithm works
58
6.4 ST Alarms
60
6.5 Intraoperative placement of electrodes
60
04|05
7.0 Conclusion
63
8.0 Glossary of Terms
64
9.0 References
68
10.0 Recommended Further Reading
70
The purpose of this manual is to provide you with a foundation of basic clinical knowledge about the monitoring of myocardial ischemia and to offer support in using ECG monitoring to achieve the highest standards of perioperative care.
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